Superficial endometrial spread of squamous cell cervical carcinoma: a diagnostic challenge at magnetic resonance imaging

Superficial Spreading Cervical Squamous Cell Carcinoma Manifesting as Intrauterine Mural Nodules on Magnetic Resonance Imaging

Superficially spreading cervical squamous cell carcinoma (SCC) is the superficial extension of SCC of the cervix into the uterine lumen, replacing the endometrium. Here, we report a case of superficially spreading cervical SCC manifesting as intrauterine mural nodules with restricted diffusion on magnetic resonance imaging (MRI). A 76-year-old woman with a history of conization presented with a pelvic mass. MRI revealed a large cystic lesion with mural nodules and wall thickening. The nodular lesions and thickened walls showed high signal intensity on diffusion-weighted imaging (DWI) and low signal intensity on apparent diffusion coefficient (ADC) maps. We performed a laparotomy for diagnosis and treatment and suspected that the tumor was of uterine origin. Hysterectomy and bilateral adnexectomy were performed. Histopathological examination revealed superficial spreading of the cervical SCC. Superficially spreading cervical SCC can manifest as intrauterine mural nodules on MRI. DWI is useful for delineating this disease. If mural nodules or endometrial thickening with restricted diffusion are found in the uterine lumen, clinicians should consider the possibility of the superficial spread of cervical SCC.

Ichthyosis uteri: a keratinizing squamous metaplasia of the endometrium with premalignant potential

•Ichthyosis uteri is a rare condition describing extensive endometrial keratinization.•There may be an association with squamous cell carcinoma of the endometrium.•Endometrial extension of cervical malignancy may closely resemble ichthyosis.•A hysterectomy should be considered in patients who have completed childbearing.

Superficial spreading cervical squamous cell carcinoma in situ involving the endometrium: a case report and review of the literature

BACKGROUND

The spread of cervical squamous cell carcinoma to the inner surface of the uterus with replacement of the endometrium is rare. Continuity of the lesion must be demonstrated to confirm superficial spread and rule out concomitant endometrial cancer.

CASE PRESENTATION

We present the case of a 66-year-old white woman with superficial spreading squamous cell carcinoma of the cervix that involved the endometrium. Her relevant past history included conization of the cervix to treat cervical intraepithelial neoplasia III with positive margins. She subsequently had three negative cervical vaginal cytology results, each with a positive high-risk human papillomavirus test. Transvaginal ultrasound showed occupation of the entire uterine cavity by dense material consistent with pyometra in addition to myometrial thinning due to tension and cervical dilation. The patient presented with greenish vaginal discharge of 3 months' duration. The cervix was not visible during speculum examination. Access for endometrial sampling was not possible, raising suspicion of post-conization cervical stenosis. The patient was treated with laparoscopic hysterectomy with double adnexectomy. Histologic examination showed superficial squamous cell carcinoma invading the cervix to a depth of 2.8 mm; superficial spreading squamous cell carcinoma in situ was also observed in the lower uterine segment and endometrium. The patient was free of symptoms 12 months after surgery.

CONCLUSIONS

Squamous cell carcinoma of the cervix with superficial spread to the endometrium is not included in the 2020 (fifth edition) World Health Organization Classification of Female Genital Tract Tumors or the 2018 International Federation of Gynecology and Obstetrics cervical cancer staging system. More clinical cases are needed to identify other prognostic factors and inform clinical practice guidelines on the management of this disease.

A review and case report of enigmatic superficial endometrial spread of cancer of the uterine cervix: Need for vigilance in the primary care setting

Cervical cancer is a leading cause of cancer-related morbidity and mortality. It usually spreads via direct invasion and lymphatics. Few cases with superficial spread to the uterine endometrium, fallopian tubes, and ovaries have been observed. The staging of these cases, as well as management, is not yet clear due to limited data. The Federation of Gynecology and Obstetrics (FIGO) staging disregards uterine spread to upstage the disease, and it also fails to provide clear guidelines regarding the superficial extension to the ovaries and tubes which is not uncommon in these cases. A 63-year-old female with postmenopausal bleeding was diagnosed with squamous cell carcinoma on a pap smear. Ultrasound and magnetic resonance imaging revealed a predominant endometrial lesion. Histopathology after Wertheim's hysterectomy revealed a squamous cell carcinoma of the endocervix, stage 1B2, that had spread superficially to the endometrium. A total of 48 cases of cervical cancer with superficial spread were identified. The commonest complaint was postmenopausal bleed in 39.39%. In 50% of the cases, the disease was carcinoma in situ, and 70.45% of the women had disease of stage 1B or less. In many cases, the disease had reached the tubes, 36.66%, and ovaries 23.33%. All women with stage 2A or lesser disease except for one were alive at 6 months after surgery. Superficial spread of cervical cancer is a distinct entity. Endometrial pathology must be ruled out before planning management in these women, especially when managing early-stage disease with conservative therapy.

Unusual form of squamous cell carcinoma of the cervix extending in situ into the endometrium: Three case reports and review of literature

Squamous cell carcinoma of the cervix is the most common gynecological malignancy in India. Direct extension from a cervical growth can involve the uterine corpus, but a superficial spread, without invasion of the underlying myometrium, is uncommon. We report three cases of squamous cell carcinoma of the cervix, with superficial extension to the whole endometrial cavity, by expansile intraepithelial growth. Clinically, two of our cases presented with pyometra and one with vaginal bleeding and discharge. The tumor had spread superficially into the entire endometrial cavity, up to the fundus, replacing the columnar epithelium totally. This was a rare phenomenon, with fewer than 30 cases reported in literature.

Unusual form of superficial spreading squamous cell carcinoma of cervix involving the endometrium, bilateral tubes and ovaries: a case report with literature review

OBJECTIVE

Although the majority of metastatic ovarian tumors arise within the female genital tract, squamous cell carcinoma of the cervix is a rare form of metastases to the bilateral ovaries by endometrial and transtubal spreading.

CASE

A 53-year-old woman was referred to the oncology clinic with postmenopausal bleeding. On vaginal examination, a 3 cm tumor arising from the cervix was inspected. Multiple cervical biopsies and endocervical curettage revealed large cell, non-keratinized squamous cell cervix carcinoma. Radical hysterectomy and bilateral salpingo-oophorectomy were performed. Bilateral pelvic and para-aortic lymph nodes were also removed. The final pathology report revealed endometrial, focal myometrial, bilateral tubal mucosal, fimbrial and bilateral ovarian squamous cell carcinoma involvement. Pelvic and para-aortic nodes were free from metastases.

CONCLUSION

Although the incidence of ovarian metastases of adenocarcinoma of the cervix is significantly higher, squamous cell carcinoma may also metastasize to the ovaries by endometrial and transtubal spreading in the absence of lymph node involvement. Especially in young patients for whom preservation of the ovaries is supposed, gross intraoperative inspection of the radical hysterectomy specimen and endometrium should be done and ovaries should be evaluated carefully.